myra levine

The theorist Born in Chicago, first child in a family

of 3 siblings, Her experiences during her father’s

frequent illnesses contributed to her interest in and dedication to nursing.

1944- Diploma- cook County School of Nursing

1949- B.S. in Nursing from the University of Chicago

1962- M.S. in Nursing Wayne State University

Career

Private duty Nurse, civilian nurse for the U.S. army, surgical supervisor, Director of Nursing

Faculty Positions: Loyola University, Cool County School of

Nursing, Rush University, University of Illinois, Chicago.

Professor Emerita, Medical Surgical Nursing, University of Illinois, Chicago.

Visiting Professorship Israel: Tel Aviv University and Recanati School

of Nursing, Ben Gurion University of Negev

Honors and Awards 1973- Charter Fellow in the American

Academy of Nursing 1976-Honorary membership in the

American Mental Health Aid to Israel 1977- honorary recognition by the

Illinois Nurses Association. 1992- Granted: Honorary Doctorate,

by Loyola University, Chicago First recipient of : Sigma Theta Tau’s

Elizabeth Russell Belford Award for Teaching excellence.

Introducing...

MYRA ESTRIN LEVINE

Major Concepts and definitions: Holistic- (quotes Erikson) “ wholeness

emphasizes a sound, organic, progressive, mutuality between diversified functions and parts within an entirety, the boundaries of which are open and fluent.”

Holism- “ human beings are more than and different from the sum of their parts”

Integrity- from the latin word integer meaning “one” integrity means being in control with one’s life.

Nursing:

Nursing is a human interaction, “ when nursing intervention influences adaptation favourably, or toward renewed social well being, then the nurse is acting in a therapeutic sense, when the response is unfavourable, the nurse adds supportive care. The goal of nursing is to promote wholeness.

Person

Is who we know ourself to be, or a sense of

identity.

Health

Is socially determined. It is predetermined by Social groups and is not just the absence of pathological conditions

Change is characteristic of life, and adaptation is the method of change.

Environment

Is the context in which we live our lives. It is not a positive backdrop, we are active participants in it.

Composed of Internal and external environments

(to be elaborated in the conservation principles)

Assumptions An underlying assumption of Levine’s model is

that the nurse creates an environment in which healing can occur and adaptation is promoted. Individuals are constantly interacting with an external environment; consequently, they adapt and preserve their energy and integrity in accordance with that environment. However, when an individual can no longer maintain that energy and integrity, health is adversely affected. This environment pertains not only to the external milieu, but also to the individual’s internal environment.

The conservation theory...

Theoretical Sources: 1. Beland’s theory of specific

causation and multiple factors- the way people think about disease changes over time.

2. James E. Gibson-definition of perceptual systems

3. Erik Erikson- differentiation between total and whole

4. Hans Selye- Stress theory 5. M. Bates- Models of external

environment Martha Rogers: her first editor

conservation Conservation- is from the latin

word meaning conservation meaning to keep together.

“conservation describes the way complex systems are able to continue to function even when severely challenged.

Through conservation, individuals are able to confront

obstacles and adapt accordingly while maintaining

their uniqueness.

Conservation

The goal of conservation is health

The primary focus of conservation is on the integrity of “oneness” of

the individual

Conservation principles:

a conceptual model of nursing that focuses on conservation of the person's wholeness.

Adaptation

Adaptation is the process by which people maintain their wholeness or integrity as they respond to environmental challenges.

Adaptation, according to Levine,is a process of change whereby the individual retains his integrity within the realities of his environment. It is the way in which the person and the environment become congruent over time. It is the fit of the person with his or her predicament of time and space. (shoes)

Environment

Environment: is: “where we are constantly and actively involved. The person and his relationship with his environment is what counts.

Levine views the environment to which an individual adapts as being both internal and external.

Environment: Internal

The INTERNAL ENVIRONMENT is the physiological and pathophysiological aspects of the patient. It is the integration of bodily functions that resembles a stabilized flow (homeorrhesis) rather than a static state (homeostasis) and is subject to challenges of the external environment, which always are a form of energy.

Environment: External

The EXTERNAL ENVIRONMENT is divided into the:

Perceptual environment Operational environment Conceptual environment

The PERCEPTUAL ENVIRONMENT is that portion of the external

environment which individuals respond to with their sense organs and includes light, sound, touch, temperature, chemical change that is smelled or tasted, and position sense and balance.

The OPERATIONAL ENVIRONMENT is that portion of the external

environment which interacts with living tissue even though the individual does not possess sensory organs that can record the presence of these factors and includes all forms of radiation, microorganisms, and pollutants.

The CONCEPTUAL ENVIRONMENT is that portion of the external

environment that consists of language, ideas, symbols, and concepts and inventions and encompasses the exchange of language, the ability to think and experience emotion, value systems, religious beliefs, ethnic and cultural traditions, and individual psychological patterns that come from life experiences.

Organismic response

The capacity of the individual to adapt to his environmental condition

Divided into 4 levels of integration Fight or flight Inflammatory response Response to stress Perceptual response

The 4 conservation Principles

CONSERVATION OF ENERGY

CONSERVATION OF SOCIAL INTEGRITY

CONSERVATION OF PERSONAL INTEGRITY

CONSERVATION OF STRUCTURAL INTEGRITY

CONSERVATION OF ENERGY

is a natural law found to hold everywhere in the universe for all animate and inanimate entities. Nursing intervention is based on balancing the individual’s energy input with energy output. The individual requires a balance of energy and a constant renewal of energy to maintain life activities.

Conservation of energy has long been used in the nrsing practice:e.g. providing care that makes the least additional demand possible.

CONSERVATION OF STRUCTURAL INTEGRITY

focuses attention on restoring structural integrity and healing. Nursing intervention is based on limiting the amount of tissue involvement in infection and disease, by early detection of functional changes and by nursing interventions;

e.g. prevention of pressure ulcers

CONSERVATION OF PERSONAL INTEGRITY

focuses attention on the patient as a person. Nursing

intervention is based on helping the individual to

preserve his or her identity and selfhood.

CONSERVATION OF SOCIAL INTEGRITY

focuses attention on the individual's place in his or her family, community, and society. Self worth and a sense of Identity is important.

Nursing intervention is based on helping the individual to preserve his or her place in a family, community, and society. The nurse’s goal is always to impart knowledge and strength so that the individual can resume a private life.

Summary of the conservation principles

conservation of energy — balancing energy output and input to avoid excessive fatigue  

conservation of structural integrity — maintaining or restoring the body structure by preventing physical breakdown and promoting healing

conservation of personal integrity — maintaining or restoring the patient’s sense of identity and self-worth and…acknowledging uniqueness      

conservation of social integrity — fostering awareness that the patient…is a social being who interacts with others in their social environment.

The principles applied in the

Nursing Process...

Assessment

Principles of conservation used

as guides in assessing

Conservation of Energy

primary focus: identifying the areas of energy expenditure that are related to the suffering that brought the patient into contact with the nurse. Information about the balance on energy input and output is also important.

Data would include: Vital signs, Lab values related to uptake and use of oxygen and nutrients, activities of daily living, nutrition, exercise, elimination, menstrual cycles...

any aspect of living that requires energy.

Conservation of Structural Integrity:

would relate to information about injury and disease processes.

Data would include: lab values that reflect the immune/inflammatory response, direct observation of wounds, and any visible indication of disease, and information from the patient about symptoms that are not observable.

Conservation of personal Integrity

– needs to be collected very carefully... Levine warns about the threat to the self of the

patient that can be created if the nurse seeks a too thorough investigation of the self of that patient.

Guideline: use only those generalizations that actually make a difference in the choice of treatment plans.

To assist in maintaining independence, assessment needs to be limited to those portions of the self that the patient is willing to share, and is capable of sharing.

Conservation of Social Integrity

includes information about others who have influenced the person’s identification of self

Again, the kind and amount of data collected in this area has to be constructed carefully, with due sensitivity to the needs of the person to maintain privacy.

Diagnosis:

she suggests trophicognosis: which is a nursing care judgement that is arrived at through the use of the scientific method. (not adopted by the nurses)

The nursing Diagnosis : focuses on the cause of the patient’s suffering—what has put him or her in the predicament of need—and on the areas in which adaptation needs to be supported in order to achieve conservation and integrity.

Outcomes:

Goal of returning the patient to a state of

independence as early and efficiently as possible

Planning:

no specific structure, Focus: what the nurse needs to do

to aid the patient to regain independence, as quickly and as fully as possible.

Implementation:

Guided by the 4 conservation principles...

Conservation of Energy:

Balancing energy input with output

Input: example improved nutrition

Output: example: Activity changes ( bed rest)

Conservation of structural Integrity: based on limiting the

amount of tissue involvement in infections

and disease. Example: appropriate positioning to

prevent decubiti, dressing changes etc.

Conservation of Personal Integrity:

based on helping the person preserve his or her identity and selfhood.

Example: deciding to protect the patient’s private self by being careful to collect only data that would influence the patient’s plan of care, and proceeding with the design of treatment plans that take individual characteristics into account.

Conservation Social Integrity:

based on helping the patient to preserve his or her place in a family, society and community.

May include: Teaching the family about the patient’s care needs or teaching persons with colostomies how to handle food and fluid intake and how to change the ostomy bag in a manner that helps to minimize its being evident to those they meet.

Evaluation:

Evaluate to know if the person’s suffering has been alleviated and

that he or she is willing and capable of no longer being

dependent. The evaluation data focus on the effectiveness of

adaptation in achieving conservation and integrity in the 4

areas of conservation.

Critique...

Researchability

All in all: Levine’s model served as an excellent beginning. Its contribution has added a great deal to the overall improvement of the and development of the Nursing Knowledge.

Fawcett says: “more systematic evaluations of the use of the model in various clinical situations are needed.”

Clarity

Levine’s model possesses clarity...

Fitzaptrick and Whall believe Levine’s work to be consistent internally and externally.

Simplicity

Although the 4 conservation principles

initially appear simple, they contain subcontents and

multiple variables.

Generality-

the 4 conservation Principles can be used in

all nursing contexts

Empirical Precision

Levine used deductive logic to develop her model, which can be

used to generate research questions.

Strengths

Universality: her concepts apply to all human beings wherever they may be.

She also indicates when nursing is needed—it is needed by the person in a predicament of illness who is willing to become dependent in relation to that predicament.

Thus the use of this work is not limited to any given setting but may be used wherever there is a nurse and a patient.

Strengths

Careful use of words: Careful use of terminology provides

clarity to the reader Provides clear connections to the works

of others9adjunct disciplines) and helps readers understand how these works can be used in a way specific to nursing.

Her stress on the wholeness of the person and the importance of integrity is very useful.

Limitation

Despite the comprehensiveness and wide application of Levine’s theory, the model is not without limitation.

The need for each nurse to create his or her own assessment tool to use Levine’s conservation principles...

Limitations Levine’s conservation model focuses on

illness as opposed to health; thus, nursing interventions are limited to addressing only the presenting condition of an individual. Hence, nursing interventions under Levine’s theory have a present and short-term focus and do not support health promotion principles, even though health promotion is an essential component of current nursing practice. Thus, Levine’s model does not add support to the use of interventions that prevent ulcer occurrence and reoccurrence in susceptible individuals.

Summary

Myra Levine’s theory has evolved from a publication whose initial intention was the organization of medical-surgical nursing content to facilitate student learning.

Her theory interrelates the concepts of adaptation, conservation, and integrity

Adaptation is the process by which conservation occurs.

Human Beings are in constant interaction with their environments.

It is this Interaction that creates the need for Adaptation...

As the environment changes, the person must adapt...

Successful Adaptation will achieve the best fit with the environment and will do so in a manner that conserves energy, structural integrity, personal integrity, and social Integrity.

The purpose of Conservation is Health or Integrity—the wholeness

of the person.